Chronic Otitis Media Research Articles

Our Experience with Labyrinthine Fistula: Prospective Hearing Outcomes.

Chronic otitis media with cholesteatoma is a locally destructive middle ear infection with bone erosive properties which can lead to fistula if erodes labyrinth. A prospective observational study was conducted at tertiary health care centre with a total of 12 patients who presented with complaints of otorrhoea, hearing loss and vertigo. Such patients were evaluated clinic audiologically and radiologically as a pre op assessment. Post-surgery audiological assessment was done. Hearing preservation was seen in 91.7% patients and none of the patients had iatrogenic sensorineural hearing loss. Complete removal of the cholesteatoma is beneficial and does not lead to any iatrogenic SNHL when performed meticulously. A newer way of diagnosing membranous labyrinthine breach utilizing Magnetic Resonance Imaging T2 Diffusion Weighted (MRI- T2 DW) sequence can be implemented.

Chronic suppurative otitis media – comorbidities, management and return to sports activities

Chronic suppurative otitis media – comorbidities, management and return to sports activities

Auditory and Psychological Impacts of Tympanoplasty in Chronic Suppurative Otitis Media Patients: A Mixed-Methods Study.

The online version contains supplementary material available at 10.1007/s12070-024-04907-1.

Comparative Effectiveness of the Oral versus Topical Ofloxacin to Reduce the Discharge in Chronic Suppurative Otitis Media: A Randomized Control Trial

Objective: The objective of the study was to assess the reduction rate of discharge in chronic suppurative otitis media with the use of oral vs topical Ofloxacin. Methodology: It was a randomized control trial conducted in the Department of Otorhinolaryngology Head and Neck surgery PIMS Islamabad from 26-06-2019 to 26-12-2019. The study was commenced with the approval from the ERB (Ethical Review Board). Non-probability consecutive sampling technique was used. Sample size was calculated using WHO calculator which was 98 with 49 patients in each group A & B. Participants of group A received topical Ofloxacin whereas, in group B received oral/systemic Ofloxacin. Efficacy of oral and topical drug was compared after two weeks of the start of the treatment. Data analysis was done using SPSS version 23. Results: According to gender distribution, there were 67.3% (n=33) males and 32.7% (n=16) were females in group A whereas, there were 61.2% (n=30) males and 38.8% (n=19) were females in group B. The mean age of the participants of group A was recorded as 27.0 years ± 9.4 and 26.6 years ± 10.1 in group B. Mean disease duration in group A was recorded as 2.6 years ± 2.1 and 2.4 years ± 1.9 in group B. A pus discharge was recorded in 73.5% (n=36) patients, pus and blood stained discharge in 26.5%, (n=12), 89.8% (n=44) had redness and 12.2% (n=6) had edema on examination. The values for group B were 95.9% (n=47), 4.1% (n=2), 46.9% (n=23) and 6.1% (n=3), respectively. After two weeks treatment, the outcomes were considerably enhanced in patients treated with topical ofloxacin in comparison to those treated with oral ofloxacin (p<0.05 across all groups). Conclusion: Topical ofloxacin is a better agent as compared to orally available in resumption of discharge in CSOM. More, multicenter studies with an enlarged sample size are suggested to strengthen the evidence.

Metronidazole-induced encephalopathy

A 27-year-old male with a long-standing history of chronic otitis media developed a right temporal cerebral abscess. He underwent a mastoidectomy and was treated with intravenous antibiotics, including metronidazole. The patient’s clinical condition showed signs of improvement.

Anti-inflammatory response to 1,8-Cineol and associated microbial communities in Otitis media patients

Chronic Otitis Media (COM) is defined as long term inflammation and colonization with pathogenic bacteria due to a defect or retraction of the tympanic membrane. Surgical interventions are often augmented by antibiotic resistance development and therefore, off-label treatment using the natural drug 1,8-Cineol was carried out. All COM patients underwent antibiotic therapy and middle ear surgery and developed antibiotic resistances. Microbiological investigations from the auditory canal and stool samples were performed in correlation with the clinical course. Therapy of COM patients with 1,8-Cineol revealed a clear reduction of inflammatory microbes P. aeruginosa and Proteus mirabilis in ear samples as well as intestinal Prevotella copri, which was associated with an improved clinical outcome in certain individuals. The present off-label study revealed manifold anti-inflammatory effects of the natural monoterpene 1,8-Cineol in Otitis media patients. A better understanding of the underlying mechanisms will improve the current treatment options and possible forms of application of this natural drug.

Role of Tympanometric Ear Canal Volumes in Determining Outcome of Myringoplasty in Chronic Suppurative Otitis Media Patients.

Middle ear aeration is a predictive indicator of myringoplasty's successful outcome and tympanometric ear canal volume is a novel investigation that can estimate the volume of middle ear cleft and mastoid air cells. Our aim of this study is to determine the role of tympanometric ear canal volume on myringoplasty outcome in Chronic Suppurative Otitis Media Patients. Prospective analysis involving 50 patients of CSOM was performed on patients undergoing myringoplasty from April 2022 to December 2023. Smokers, Patients with squamosal COM, Bilateral COM, Otitis Externa, and Revision surgery were excluded from the study. The successful outcome of surgery was defined as no tympanic membrane perforation on postoperative follow-up. Analysis was carried out using SPSS. V. 25 and P-value less than 0.05 was considered significant. A total of 50 patients were included in the study with a mean age of 24.4 ± 8.965 and male predominance. Overall graft uptake was 64%. Graft uptake had no significant statistical correlation with age, gender, type, location, or size of perforation. However, there is a significant effect of tympanometric ear canal volume of pathological ear and interaural tympanometric ear canal volume difference on graft uptake with p-values of 0.023 and 0.033 respectively. Tympanometric ear canal volume can predict middle ear aeration and the higher the interaural tympanometric canal difference more are the chances of successful graft uptake.

Microbiological Profile of Ear Infection in Patients with Chronic Suppurative Otitis Media

Ear infections occur in all age groups. Chronic Suppurative Otitis Media (CSOM) is the most common illness in ear, nose and throat (ENT) practice. It may even cause hearing impairment especially sensory – neural deafness if not treated properly and with caution. The aim from the present study is to assess the frequency of microbial agents in chronic suppurative otitis media and the antibiotic susceptibility patterns of isolates among patients. A total of 65 patients clinically diagnosed with chronic suppurative otitis media, the samples were collected using sterile swabs. All bacterial and fungal isolate were identified by conventional microbiological methods. Antibiotic susceptibility patterns of the bacterial isolate were determined by Kirby–Bauer disc diffusion method. Out of total 65 samples 45 (69.2%) positive culture was Pseudomonas aeruginosa (28.8%) were the most prevalent bacteria isolated, followed by Staphylococcus aureus (22.2%) Proteus mirabilis (11.1%) Klebsiella (6.6%), E. coli (4.4%), Staphylococcus epidermidis (4.4%) and Streptococcus pyogenic (4.4%). Candida albicans (13.3%) was the most common fungus causing CSOM. The most effective antibiotic for treatment of bacterial chronic suppurative otitis media was ceftriaxone, meropenem and amikacin. It is important to know the major microbial etiologies of CSOM and their antibiotic susceptibility patterns, both for selection of the most appropriate treatment regimen and prevention of the emergence of resistant strains.

Tele-otology for Aboriginal and Torres Strait Islander People Living in Rural and Remote Areas.

To evaluate a referral-based, tele-otology service in rural and remote areas of the Northern Territory, Australia. A retrospective observational cohort study was performed of a tele-otology service in 93 Aboriginal and Torres Strait Islander communities (2011 to 2019). Assessments included face-to-face examinations performed by Clinical Nurse Consultants and audiologists, and asynchronous reviews performed by otolaryngologists. Multivariable logistic regression was performed to determine the likelihood of ear disease, adjusted for age and gender. Intra- and inter-rater agreement was assessed between otolaryngologists. A total of 3,950 patients were reviewed (6,838 encounters, 13,726 ear assessments). The median age of patients was 9.8 years (interquartile range: 7.2 years). Overall, 62.2% of patients were identified with ear disease and 62.5% identified with hearing loss. Substantial intra- and inter-rater agreement in diagnosis was found between otolaryngologists (κ = 0.71 and κ = 0.78, respectively). The most common ear conditions identified were chronic otitis media (COM, 28.1%) and otitis media with effusion (OME, 16.5%). Topical or oral antibiotics were initiated in 14.1% of all encounters, most often for acute otitis media or COM. Surgery was recommended in 27.7% of all encounters, most often myringoplasty, adenoidectomy, and myringotomy with insertion of tympanostomy tubes. Tele-otology is a critical component of an integrated approach to evaluating ear disease in Indigenous people living in rural and remote areas. The high prevalence of OME, COM, and surgical recommendations highlights the need for community engagement, regular follow-up, and early interventions to prevent long-term hearing loss. N/A Laryngoscope, 2024.

Changes in paranasal sinus volumes, temporal bone pneumatization, internal acoustic canal and olfactory cleft dimensions over the centuries: a comparison of skulls from different epochs in Anatolia

ObjectivesInvestigating changes in temporal bone pneumatization (TBP) and paranasal sinus volumes (PSV) across different eras may help understanding not only changes in skull anatomy but also pathophysiology of chronic otitis media and sinusitis, respectively, which are common health problems.MethodsEight skulls from the second century AD, 20 skulls were from the 10th–11th centuries AD, 20 skulls from the 16th–19th centuries AD, and 60 contemporary skulls were included in this cross-sectional observational study. Using computerized tomography (CT) scans, the PSV were calculated by multiplying the height, width, and antero-posterior distance of the sinuses. TBP was divided into three types. Internal acoustic canal (IAC) length and width, and olfactory cleft (OC) width were measured.ResultsNo statistically significant differences were found between the paranasal sinus (frontal, maxillary, and sphenoid) volumes between the groups. However, TBP decreased statistically significantly over time on both sides of the skulls (p = 0.001). The contemporary IAC and OC measures were found to be significantly lower on both sides compared to the skulls from the other three eras (p < 0.001 for both).ConclusionsAlthough no significant change was observed in PSV, decreases were evident in TBP, OC width and IAC length and width over time. It appears a fair inference that changes in size of OC and IAC might be another indication of the fact that olfaction and hearing were more vital for survival in old eras. Since we do not know incidence of chronic ear problems in old eras, we cannot speculate outcome of increased TBP in terms of developing chronic ear diseases. On the contrary, increased TBP was likely to play a protective role in traumas in old ears. Additionally, the environmental influences may be crucial role in the development of paranasal sinuses.

Efficacy of Empirical Co-Amoxiclav Vs Culture Directed Treatment in Chronic Suppurative Otitis Media. A Double Blind Randomized Controlled Trial

Background: Chronic suppurative otitis media (CSOM) is common middle ear inflammatory condition secondary to tympanic membrane perforation and superimposed infection, which causes increased discharge from middle ear mucosa. This is a common condition seen in relatively low socioeconomic status and in younger population. The effective treatment of this disease is essential as un-treated patients often lead to various complications like mastoiditis, facial nerve paralysis, labyrinthitis and abscess formation. A huge number of hearing loss in paediatric population is due to this condition. The treatment of CSOM includes aural toilet, topical antibiotics and in some cases systemic antibiotics. In this study we will compare the results of patients who were given culture sensitivity directed antibiotics with the ones who were given Co-Amoxiclav as an empiric treatment Methodology: A two-year observational cross-sectional study was conducted at PIMS, a total of 396 patients were enrolled and randomly divided into two group i.e., Group A and Group B with 198 patients in each. Group A included those who were given culture specific antibiotics and group B included those who were given Co-Amoxiclav as a part of empiric therapy. Their results were compared after 12 days of treatment in terms of response seen as clean and dried, external auditory canal along with middle ear mucosa. Results: Out of 198 patients in Group A, 177 patients had clean and dried middle ear mucosa which shows success rate of 89.39% and in Group B 170 patients out of 198 (85.85%) showed positive response. Conclusion: Empiric treatment of CSOM (Tubotympanic Type) with co-amoxiclav must be considered as its response is comparable to culture sensitivity directed treatment in terms of clean and dried external auditory canal and middle ear mucosa.

Revision mastoidectomy in a patient with unsafe Chronic Suppurative Otitis Media (CSOM): a case report

Background: Chronic suppurative otitis media (CSOM) with cholesteatoma can locally be destructive. Radical mastoidectomy is a procedure to clean and remove all cholesteatoma. However, there is a 38-60% chance of recurrence after the procedure, and the subsequent intervention is a more difficult and risky revision mastoid operation. In this study, we reported a 56-year-old woman with an unsafe type of CSOM who underwent revision radical mastoidectomy. Case Presentation: A 56-year-old woman presented with complaints of discharge accompanied by a hole in the left ear. The patient had previously undergone ear surgery about four years ago for similar complaints. Physical examination showed a full ear canal on the left with secretions, and the tympanic membrane was difficult to assess. A head CT scan result was suggestive of chronic mastoiditis with cholesteatoma. The patient was treated with revision radical mastoidectomy and had a good outcome. Conclusion: In conclusion, this case report presents a 56-year-old woman with recurrent unsafe type CSOM who underwent revision mastoidectomy and had a good outcome. Causes of surgical failure include a high facial ridge and inadequate meatoplasty.

Relationship Between Cochlear Lateral Wall Changes and Endolymphatic Hydrops in Otitis Media.

Despite otitis media and various disease processes being associated with endolymphatic hydrops (EH), an exact explanation of the pathophysiology has yet to be reported. This study aimed to investigate the changes in the cochlear lateral wall structures and their potential correlation with the presence and severity of cochlear EH in acute and chronic otitis media cases. The investigations were conducted in both chinchilla animal model and human temporal bone specimens. We studied a total of 15 chinchilla and 25 human temporal bones from our collection, which were categorized into acute otitis media, chronic otitis media (COM), and control groups. Through quantitative analysis, we measured the area of cochlear lateral wall structures and observed the presence and the degree of EH using light microscopy. No significant changes were determined in the area of the spiral ligament (p > 0.05) across the species. However, a significant (p < 0.05) decrease in the mean area of the stria vascularis in the basal turn was identified in COM groups compared to controls of both species. Chinchilla model additionally exhibited pathology extending to the lower mid turn. A negative correlation was found between the mean strial area and the severity of EH in both the animal model and human samples. COM associated with significant changes in the stria vascularis that may lead to significant increase in the degree of EH. The presented animal model exhibited parallel findings with human samples, suggesting its viability as a valuable model for future studies. N/A Laryngoscope, 2024.

Determining the Minimal Clinically Important Difference (MCID) and Responsiveness of the Chinese Version of Zurich Chronic Middle Ear Inventory (ZCMEI-21-Chn): A Prospective Multicenter Study.

This study aimed to establish the minimal clinically important difference (MCID) and assess the responsiveness of the Chinese version of Zurich Chronic Middle Ear Inventory (ZCMEI-21-Chn). Prospective multicenter study. Four Chinese tertiary referral centers admitting patients nationwide. 230 adult patients with chronic otitis media (COM) undergoing tympanoplasty. Patients were required to complete the ZCMEI-21-Chn to measure health-related quality of life both preoperatively and postoperatively. An anchor-based method was used to determine the MCID of the derivative cohort by including the Global Rating of Change Questionnaire as an anchor. The generalizability and consistency with functional outcomes of the MCID estimates were externally examined in a validation cohort using a receiver operating characteristic curve analysis. A total of 161 and 69 patients were included in the derivative and validation cohort. The mean preoperative and postoperative ZCMEI-21-Chn total scores were 28.4 (standard deviation [SD] 14.5) and 17.5 (SD 12.6). The mean change in ZCMEI-21-Chn score was 10.9 (SD 14.3, p < 0.001). The MCIDs of the ZCMEI-21-Chn for improvement and deterioration were estimated at 13 (SD 13.0) and -7 (SD 12.9), accordingly. For patients who have reported an improved health-related quality of life, a cutoff value of 15.6 dB HL for elevation of the air-conducted hearing threshold was noticed. However, change of clinical importance judged according to MCID and Japan Otological Society criteria disagreed with each other, notably with a Cohen's kappa ( κ ) of 0.14 ( p = 0.21) in the validation cohort. This study is the first to establish the MCID of a COM-specific questionnaire in Chinese. For the COM population undergoing surgical intervention, MCID values of 13 for improvement and -7 for deterioration are recommended. The results were externally validated to be generalizable to nationwide usage, yet distinguishable from the audiological criteria. The availability of the MCID greatly adds to the clinical utility of the ZCMEI-21-Chn by enabling a clinically meaningful interpretation of its score changes.

Tympanoplasty with and without mastoidectomy for the treatment of active efficacy analysis of chronic suppurative otitis media of simple type

Objective:To analyze the surgical efficacy and safety of tympanoplasty with and without mastoidectomy for the treatment of active simple chronic suppurative otitis media（CSOM）, and to investigate whether mastoidectomy can be avoided in tympanoplasty for active CSOM. Methods:The clinical data of 55 patients（55 ears） with active CSOM were retrospectively analyzed. Based on the development of the mastoid process and the upper tympanic chamber, patients who met the criteria for wall-up mastoidectomy were classified as group A （30 patients）, and underwent tympanoplasty combined with wall-up mastoidectomy. Patients who did not meet the criteria for wall-up mastoidectomy were classified as group B（25 cases）, and underwent tympanoplasty with the opening of the middle and upper tympanic chambers and sinus drainage after partial removal of the shield plate bone. The survival rate of tympanic membrane grafts, hearing before and after surgery, and complications such as reperforation were compared between the two groups at 3 months postoperatively. Results:The overall postoperative tympanic membrane survival rate of patients with active CSOM was 96.4%（53/55）, including 96.7% in group A; 96.0% in group B. There was no significant difference in the tympanic membrane survival rate between the two groups（P>0.05）. The postoperative mean air-bone gap（ABG） was significantly reduced in both groups compared with the preoperative period, but there was no significant difference in ABG gain between the two groups（P>0.05）. No patients experienced serious adverse conditions such as peripheral facial paralysis, cerebrospinal fluid leakage, or sensorineural deafness after surgery. Conclusion:Microscopic tympanoplasty with patency of the middle and upper tympanic chambers and tympanic sinus drainage can be used to treat active simple chronic otitis media with satisfactory tympanic membrane viability and hearing improvement efficacy. This approach reduces patient trauma, prevents complications such as skin depressions in the mastoid area due to abrasion of the mastoid bone, and shortens the waiting time before surgery.

Clinical analysis of cases of otogenic sigmoid sinus thrombosis in children

Objective:To analyze the clinical characteristics of middle ear mastoiditis combined with sigmoid sinus thrombophlebitis in children. Methods:Author retrospectively analyzed the clinical data of 6 children with middle ear mastoiditis combined with sigmoid sinus thrombophlebitis who were hospitalized in the Department of Infectious Diseases and Department of Neurology with first diagnosis of fever/headache, and subsequently underwent middle ear mastoidectomy in our department. All patients underwent comprehensive otoscopic, audiologic, imaging, and pathogenetic examinations. Clinical manifestations, pathogenetic features, treatment methods and prognosis were summarized, and the follow-up period was 3-6 months. Results:All 6 cases were first diagnosed with intracranial complications such as fever and headache in the internal medicine department. Within one month, all patients developed ear symptoms including pain, discharge, and hearing loss. Audiologic examination revealed conductive hearing loss in five cases and total deafness in one case. MRI, MRV and MRA examinations suggested that there were 6 cases of middle ear infection combined with thrombophlebitis of the ethmoid sinus, of which 3 cases had thrombus in the ethmoid sinus. 6 cases received surgical treatments: 2 cases of radical mastoidectomy+grommet Insertion, and 4 cases of radical mastoidectomy. Pathogenetic examination identified Streptococcus pneumoniae in three cases, Pseudomonas aeruginosa in one case, Enterobacter cloacae complex in one case, and no pathogens were detected in one case. Postoperative pathology was inflammatory granulation in all 6 cases. Follow-up was 3-6 months with no recurrence of intracranial and middle ear lesions on regular review. Conclusion:Children with recurrent fever, headache, and a recent history of acute and chronic otitis media should be evaluated for the possibility of sigmoid sinus thrombophlebitis, and imaging tests should be performed in a timely manner to clarify the diagnosis. Once diagnosed, surgery to remove the lesions around the ethmoid sinus, smooth drainage combined with antibiotic therapy is the most direct and effective treatment, and anticoagulation therapy is given when necessary. Timely diagnosis, multidisciplinary collaboration, and accurate timing of the management of primary foci and comorbidities are crucial to the treatment of the disease.

Antibiogram of chronic suppurative otitis media in relation to the current bacteriological profile in a tertiary care hospital

Antibiogram of chronic suppurative otitis media in relation to the current bacteriological profile in a tertiary care hospital

Pattern of Complications of Chronic Suppurative Otitis Media in Sokoto, Northwestern Nigeria

Abstract Background: Chronic suppurative otitis media (CSOM) is a potentially serious disease because of its complications. The use of antibiotics has played a significant role in the management of CSOM and its complications, and this has made otitic complications increasingly infrequent, but they are still encountered, and early recognition of clinical symptom of a complicated CSOM and prompt treatment helps to reduce morbidity and mortality associated with complicated CSOM. Complications in chronic ear disease usually follow an acute exacerbation of infection. This has resulted in a more therapeutic challenge because the underlying ear disease must be effectively treated to avert the recurrence of complications. Aim/Objective: The aim of this study was to investigate the incidence, pattern, and mortality of complications due to CSOM, which is still a major health challenge in our society. Materials and Methods: A 10-year retrospective review of clinical records of patients who were diagnosed as having CSOM with complications at Usmanu Danfodiyo University Teaching Hospital (UDUTH) Sokoto, from January 2012 to December 2021. Data extracted were: age, sex, clinical symptoms, investigations, complications encountered, treatment, and treatment outcome. Data were analyzed with IBM-SPSS Version 25.0. The complications of CSOM in this study were classified into two major categories: intracranial complications (IC) and extracranial complications (EC). Results: A total of 3970 patients with CSOM were seen in UDUTH Sokoto during the study. Forty-six patients with complications were identified, 32 (69.6%) intracranial, and 22 (47.8%) extracranial. Eight patients had both intracranial and EC. The prevalence of complications in this study was 1.2%. The male-to-female ratio was 2:1. The age ranges from 3 to 50 years with a mean age of 21.13 ± 11.73 standard deviation complications were most common among the age group of 21–30 years with 15 (32.6%) patients. Meningitis was the most common intracranial complication occurring in 15 (32.6%) patients, and subdural abscess 7 (15.2%) was the second-most common IC. In the EC, mastoiditis was the most common complication found in 17 (37.0%) patients. Conclusion: With the advent of modern and more potent antibiotics and aggressive surgical eradication of the disease, recent literatures have indicated a decline in complications of CSOM. However, morbidity and mortality are still high, and complications of CSOM still occur as a common disease in our environment. A delay in diagnosis and treatment of IC can lead to increase morbidity and mortality.

Otitic Hydrocephalus: Case Report on a Rare Complication of Chronic Otitis Media with Emphasis on Management

Abstract Otitic hydrocephalus is a rare complication of chronic otitis media (COM) and presents as a form of benign intracranial hypertension with dural venous sinus thrombosis. It presents with features of raised intracranial pressure in the absence of intracranial space-occupying lesions. Cerebrospinal fluid (CSF) shows normal cytology and biochemical picture. We present a rare case of otitic hydrocephalus in a young male who presented with an 8-year history of left ear discharge and a 2-week history of drowsiness, lethargy, progressively worsening headache, fever, blurring of vision, and imbalance. His cerebellar signs were positive, and the fundus examination detected papilledema. Imaging revealed left-sided cerebellar abscess with mastoiditis, compression of the left ventricle, and lateral and superior sagittal sinus thrombosis. Lumbar puncture showed raised CSF opening pressure. The diagnosis of COM squamosal with cerebellar abscess and otitic hydrocephalus was made. Urgent ventriculoperitoneal shunt was placed, followed by cerebellar abscess drainage and mastoid exploration. Modified radical mastoidectomy of the left ear was done with cartilage ossiculoplasty to preserve residual hearing in the patient. High index of suspicion is required in otitic hydrocephalus, where ear symptoms are masked by raised intracranial pressure symptoms. The placement of shunt to tackle raised CSF pressure preceded surgical intervention. Modified radical mastoidectomy with ossiculoplasty was performed to preserve residual hearing in this case. Prompt intervention by multidisciplinary team can reduce morbidity in these patients.

Success Of Cartilage Grafting with Mastoidectomy In Revision Tympanoplasty

Aims and Objectives: Candidates having non-cholesteatomatous chronic otitis media who have failed tympanoplasty in first attempt (graft used conchal or tragal cartilage) is at higher risk of failure in subsequent repair. The adjunctive use of mastoidectomy with cartilage tympanoplasty (tragal or conchal) in these patients has decreased the risk for subsequent failure. Aim of our study is to compare effect of mastoidectomy in revision cartilage tympanoplasty in terms of successful graft uptake, hearing improvement, and prevalence of other complications. The arguments in favor of mastoidectomy include the facts that the open mastoid cavity provides an improved volume and pressure buffer, rids the mastoid of diseased mucosa, and ensures adequate patency of the aditus (14– 16). Although this logic is sound and is supported in the literature, we believe that in many revision cases, reconstruction with a robust material such as cartilage provides the additional stability necessary to allow the middle ear and mastoid to revert naturally to a normalized environment.